After six years of intermittent groin pain, Nadine sought medical care when her symptoms became worse. An MRI revealed a cartilage tear in her right hip and she was later diagnosed with bilateral hip dysplasia. When Nadine visited me for a second opinion, I found that her right hip was worse than her left and recommended a right hip periacetabular (Ganz) osteotomy. In the months since her surgery, Nadine’s right hip pain has been resolved and she’s been able to return to her normal activities. http://www.davidsfeldmanmd.com/patient-education/case-studies/nadine-hip-dysplasia

1. Case Study: Nadine
Conditions Treated
Hip Dysplasia
Age Range During Treatment
39 years
David S. Feldman, MD
Chief of Pediatric Orthopedic Surgery
Professor of Orthopedic Surgery & Pediatrics
NYU Langone Medical Center & NYU Hospital for Joint Diseases

2. BACKGROUND

3. Following the birth of her second child, Nadine began experiencing
pain in her groin that was intermittent but would become worse with
prolonged activities. After six years, the pain began to worsen and
ascending stairs became especially painful. Following several months
of this increased pain she visited a doctor and an MRI revealed a
cartilage (labral) tear in her right hip. Surgery was recommended but
Nadine chose physical therapy instead which actually worsened her
symptoms.
Nadine followed up with a specialist who diagnosed her with bilateral
hip dysplasia and recommended a right hip periacetabular osteotomy.
Prior to this she had not been using any pain medication for relief but a
steroid injection was found to be effective. A few months later Nadine
visited me for a second opinion on her hip dysplasia.

4. EVALUATION

5. During Nadine’s evaluation, she told me that when active, she would
limp at the end of the day but I observed that she wasn’t limping when
walking short distances in the office. I found that did not limp with minor
walking around the office but reported a limp at the end of the day with
activity.
She had a good range of motion in flexion, abduction, and internal
rotation but experienced pain during flexion and internal rotation. X-rays
revealed that her hip dysplasia was worse on the right than on the left. I
concurred with the recommendation for a right hip periacetabular
(Ganz) osteotomy.

6. X-ray showing bilateral hip dysplasia as a result of shallow
acetabuli failing to provide sufficient coverage of the femoral heads.

7. TREATMENT

8. Right Periacetabular (Ganz)
Osteotomy

9. Anatomy of the Human Female Pelvis

10. A cosmetic incision was made along the bikini line to provide access to
the anterior and posterior of the hip (ilioinguinal incision). The muscles
were then separated and care was taken to protect the femoral and
lateral femoral cutaneous nerves. An osteotomy of the anterior superior
iliac spine was performed to avoid lifting muscles off the pelvis and this
avoids weakening the muscles. Homans screws were then applied
around the pubis followed by an osteotomy.
Next a partial ischium and complex ilium osteotomy were performed. A
Schanz pin was applied to the anterior superior iliac spine and followed
by a correction of the iliac wing which was fixed in place with four
3.5mm screws. Having achieved good fixation and confirming this with
x-rays, the anterior superior iliac spine was reconstructed.
The wound was irrigated, closed in layers, and dry sterile dressings
were applied.

11. X-ray of Nadine’s hip after surgery.

12. Observations

13. Nadine’s surgical wound was healed
so her sutures were trimmed and steri
strips were applied. Her hip had good
range of motion and x-rays revealed
that all hardware was in place and
there was good coverage of the
femoral head. She was instructed to
continue use of her crutches and
injections of Lovenox (anticoagulant
used to prevent blood clots) but was
to begin slowly weaning off of her
medications.
Three Weeks

14. Nadine had completely weaned
herself off of her medications and x-
rays showed that her osteotomies
were healing. She was allowed to
begin progressive weight bearing on
her right leg.
Six Weeks

15. X-rays revealed that Nadine’s
osteotomies had healed. While she
had good range of motion with no
pain she was experiencing some pain
in her groin. She was to begin
physical therapy to strengthen her
muscles and consider a non-steroidal
anti-inflammatory drug (NSAID) to
relieve pain and inflammation.
Three Months

16. CONCLUSION

17. Nadine’s case demonstrates the usual progression of patients after a
periacetabular osteotomy. In the months since her surgery, Nadine’s
right hip pain has been resolved and she now has the option of having
the hardware in her right hip removed if she chooses. She has been
cleared to resume all activities with the understanding that stretching
and exercise will remain very important.
X-rays have shown no changes to the mild case of dysplasia in her left
hip. However, as Nadine has been experiencing minimal pain in her left
groin, I will continue to follow her left hip for any changes in the severity
of pain or condition of the hip.

18. X-ray eight months after surgery showing a completely healed osteotomy and
resolved case of right hip dysplasia with good coverage of the femoral head. The
mild case of left hip dysplasia will remain under observation.

19. David S. Feldman, MD
Pediatric Orthopedic Surgeon
www.davidsfeldmanmd.com